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Neuro Flashcards

1
Q

L3 root compression? (4)

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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2
Q

L4 root compression? (4)

A

Sensory loss over anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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3
Q

L5 root compression? (4)

A

Sensory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

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4
Q

S1 root compression?

A

Sensory loss over posterolateral aspect of leg and lateral foot
Weakness of plantarflexion
Reduced ankle reflex
Positive sciatic nerve stretch test

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5
Q

When to consider MRI for root compression?

A

If symptoms persist for 4-6 weeks despite analgesia, physiotherapy and exercises

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6
Q

Initial signs of SACD development in B12 deficiency (e.g. 2 years after gastrectomy for cancer)? (3)

A

Loss of ankle reflexes
(knee reflexes may be brisk)
Loss of vibration and pin prick
Wide-based ataxia

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7
Q

Difference between migraine symptoms in kids and adults? (3)

A

In kids shorter lasting, more commonly bilateral, and GI disturbance more prominent

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8
Q

Can aura for migraine occur without headache?

3 things which make the sensory/motor disturbance an aura?

A

Yes

  1. Fully reversible
  2. Develop over at least 5 mins
  3. Last 5-60 mins
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9
Q

5 common migraine auras?

A
  • Double vision
  • Visual symptoms affecting one eye (scintillating scotoma)
  • Motor weakness
  • Poor balance
  • Decreased level of consciousness
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10
Q

Becker/Duchenne MD:

  • inheritance? problem with what gene?
  • Symptoms they have in common? (3)
  • Differences between them? (2)
  • Difference between these and myotonic dystrophy?
A

Autosomal Dominant
Dystrophin gene - large membrane protein which attaches membrane to actin in muscle

  • Progressive proximal muscle weakness
  • Calf pseudohypertrophy
  • Gower’s sign: child uses arms to stand from squatted position
  • Duchenne onset from 5 y/o, Becker’s is later in teens
  • 30% in Duchenne have intellectual impairment, this is very rare for Becker

Myotonic dystrophy - muscles have increased tone, unable to relax

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11
Q

What muscles are generally spared in MND?

A

Extraocular - eye movements spared

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12
Q

Loss of thumb abduction after colles #?

A

Median nerve injury

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13
Q

How does ulnar nerve damage present in hand?

A

Weakness of 4th and 5th fingers, with loss of sensation of these fingers also front and back

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14
Q

MRI with/without contrast should be used for demyelinating lesions e.g. MS?
What is seen on MRI with MS?
On CSF?

A

WITH contrast

MRI:

  • High signal T2 lesions
  • Periventricular plaques
  • Dawson fingers: hyperintense lesions perpendicular to corpus callosum extending up like little fingers

CSF:

  • Oligoclonal bands
  • Increased intrathecal synthesis of IgG
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15
Q

5 month old with seizures and developmental delay - EEG shows hypsarrhythmia?
What is the typical seizure of this condition like?
Prognosis?

A

Infantile spasms (West Syndrome)

Salaam attacks - flexion of head, trunk and limbs with extension of arms
(lasts 1-2 secs and repeated up to 50 times)

Poor prognosis - progressive mental handicap

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16
Q

What diet is good for treatment-resistant epilepsy in kids?

A

Ketogenic

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17
Q

1st step in first aid of patient with raised ICP?

A

Head elevation to 30 degrees

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18
Q

Causes of raised ICP? (5)

Symptoms? (5)

A
  • Idiopathic intracranial hypertension
  • Traumatic head injuries
  • Infection (e.g. meningitis)
  • Tumours
  • Hydrocephalus
Headache
Vomiting
Reduced consciousness
Papilloedema
Cushing's triad - widening pulse pressure, bradycardia, irregular breathing
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19
Q

Investigations for raised ICP? (3)

A
  • CT/MRI key to see underlying cause
  • Increased opening pressure on LP
  • Invasive - catheterisation of lateral ventricle to measure pressure
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20
Q

Management of raised ICP?

A

(Ix and treat underlying cause)

  • Head elevation to 30 degrees
  • IV mannitol
  • Controlled hyperventilation (reduce pCO2, cerebral vasoconstriction, temporary lowering of ICP)
  • Removal of CSF (e.g. repeated LP in idiopathic ICH, or ventriculoperitoneal shunt)
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21
Q 
Is Guillain Barre painful?
Cranial nerve involvement?
Autonomic involvement?
Why can papilloedema occur?
Ix? (2)
A

65% experience back/leg pain

Cranial: diplopia, bilateral facial nerve palsy, oropharyngeal weakness common

Autonomic: urinary retention, diarrhoea

Papilloedema: decreased CSF resorption

Ix:

  • LP: raised protein but normal WBC
  • nerve conduction studies: decreased motor nerve velocity
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22
Q

Apart from weakness, what other symptoms can people get with Bells’ palsy?
Management? (2)
When should they show signs of improvement?
Prognosis?

A
  1. Post-auricular pain (often precedes paralysis)
  2. Altered taste
  3. Dry eyes
  4. Hyperacusis
  • Prednisolone PO within 72 hours of onset
  • artificial tears and eye lubricants

<3 weeks - if not improvement refer urgently to ENT

Most recover fully in 3-4 months, if untreated 15% have permanent mod-sev weakness

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23
Q

Should prokinetics e.g. metoclopramide be used in kids with GI disturbance in migraines?

A

No - they should be used with extreme caution in kids due to common SE of asthenia, parkinsonism and depression

(reserved for chemo etc)

(also they are generally CI in epilepsy)

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24
Q

Tuberous sclerosis:

  • inheritance?
  • 2 neurological features?
  • 5 derm features?
  • 1 in eye?
  • 1 in kidney?
A

Autosomal Dominant

Neuro:

  • Epilepsy
  • Intellectual impairment

Skin:

  • Depigmented ash-leaf macules (fluoresce under UV)
  • Roughened patches of skin over lumbar spine (Shagreen patches)
  • Angiofibromas in butterfly distribution over nose (adenoma sebacum)
  • Subungal fibromas
  • Cafe-au-lait macules

Eye:
- Retinal hamartoma

Kidney:
- PKD

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25
Q

What are the 4 Parkinsons Plus syndromes?

A
  • Multiple System Atrophy
  • Lewy Body Dementia
  • Progressive Supranuclear Palsy
  • Corticobasal degeneration
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26
Q

Apart from parkinsonism, what 3 other things are seen in progressive supranuclear palsy?
Response to drugs?

A
  • Impairment of vertical gaze: down worse than up (complain of trouble reading/descending stairs)
  • Postural instability and falls (stiff, broad-based gait)
  • Cognitive impairment (frontal lobe dysfunction)

Poor response to L-dopa

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27
Q

Motor weaknesses in common perineal nerve injury? (3)
Sensory loss (2)
What muscle compartments will have wasting? (2)

A

Weakness of:

  • foot dorsiflexion
  • foot eversion
  • extensor hallucis longus

Sensory loss:

  • dorsum of foot (incl 1st web space)
  • lower lateral part of leg

Wasting of:
- anterior and lateral leg compartment muscles
(anterior = deep; lateral = superficial)

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28
Q

What blood component is it important to check in workup of TIA? Why?

A

Glucose

Hypoglycaemia can cause focal neurological symptoms and mimic TIA

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29
Q

How is a TIA defined?

A

New definition is tissue based:
A transient episode of neurological dysfunction caused by focal brain, cord or retinal ischaemia, without acute infarction

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30
Q

Immediate management of a TIA?
Referral if suspected TIA in last 7 days?
If suspected TIA >7 days ago?
What is a crescendo TIA and what is the referral for this?
Referral if suspected cardiac/carotid source of stroke?
Driving after suspected TIA?

A

RULE OUT BLEED!!!
Give aspirin 300mg immediately
(unless bleeding disorder, already taking low-dose aspirin or it is CI)

  • Be seen in <24 hours by stroke specialist
  • Be seen asap in <7 days by a stroke specialist

Crescendo TIA = >1 TIA - admit for observation urgently

  • also admit for observation urgently

Don’t drive until after being seen by specialist

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31
Q

Antithrombotic therapy post-TIA?

When is carotid endarterectomy performed?

A

Clopidogrel 1st line

Aspirin + dipyramidole 2nd line (if cannot tolerate clopiogrel e.g. diarrhoea)

  • If stenosis >70% and stroke/TIA in carotid territory
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32
Q

How to tell if a 3rd nerve palsy is a surgical problem?
3rd nerve palsy due to posterior communicating artery aneurysm?
Other causes of 3rd nerve palsy? (5)

A

Pupil is dilated

Painful - pain around/behind the eye and/or generalised headache, 3rd nerve palsy and dilated pupil

  • diabetes
  • vasculitis (GCA, SLE) or others (MS, amyloid)
  • uncal herniation through tentorium if raised ICP
  • cavernous sinus thrombosis
  • Weber’s syndrome: ipsilateral 3rd nerve palsy with contralateral hemiplegia - midbrain stroke
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33
Q

Post-LP headache:

  • when does it come on?
  • how long does it last?
  • what position is it worse in?
  • if it doesn’t resolve in set time period?
A

24-48 hours (occurs due to low pressure)

  • <72 hours
  • worse when upright (better lying down)
  • If >72 hours then treatment indicated to prevent subdural haematoma:
    blood patch, epidural saline or IV caffeine
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34
Q

Scoring system for suspected stroke?

A

After FAST

ROSIER:
First exclude hypoglycaemia, then stroke is likely if any of the following:
- LOC/syncope
- Seizure activity
- Asymmetrical facial, arm or leg weakness
- Speech disturbance
- Visual field defect

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35
Q

Ix for suspected stroke?

A

Non-contrast CT

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36
Q

Who can initiate treatment for Parkinson’s?

1st line?

A

Specialists only

1st line:

  • if motor symptoms affect QOL: levodopa
  • if not affecting QOL: dopamine agonist, MAO-B inhibitor or levodopa
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37
Q

Unwanted effects of levodopa? (5)
Why can it not be stopped immediately?
What type of Parkinsonism is it not used in?

A 
Dyskinesia (involuntary writhing)
'On-off' effect
Dry mouth
Postural hypotension
Psychosis

DO NOT stop levodopa immediately - risk of acute dystonia

NOT used in drug-induced parkinsonism

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38
Q

What dopamine agonists are mainly used in Parkinsons?

Why try to avoid ergot-derived ones such as cabergoline or bromocriptine?

A

Ropinorole or Apomorphine

Cabergoline/Bromocriptine can cause retroperitoneal, cardiac and pulmonary fibrosis. Before commencing baseline echo, creatinine and CXR should be taken and monitor patients closely

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39
Q

Example of a MAO-B inhibitor?

How does it work?

A

Selegiline

Inhibits breakdown of dopamine. Higher doses also prevent breakdown of serotonin and NA (antidepressant)

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40
Q

2 examples of COM-T inhibitors?

How is it used?

A

Tolcapone, entecapone

In conjunction with levodopa as it prevents breakdown of dopamine

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41
Q

What type of drugs are used for drug-induced parkinson’s?

A

Antimuscarinics - procyclidine, trihexyphenidyl etc

Help tremor and rigidity

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42
Q

For each of these where is the lesion and describe the aphasia:

  • Wernicke’s?
  • Broca’s?
  • Conduction?
  • Global?
A

Wernicke’s (Receptive):

  • Lesion in superior temporal gyrus (MCA)
  • Comprehension impaired, speech is fluent but makes no sense - ‘word salad’

Broca’s (Expressive):

  • Inferior frontal gyrus (MCA)
  • Comprehension normal, speech is non-fluent and halting

Conduction:

  • Lesion in arcuate fasciculus (between broca and wernicke)
  • speech fluent but repetition is poor - aware of errors they are making

Global:

  • Lesion affecting all 3
  • Severe receptive and expressive aphasia - can communicate using gestures
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43
Q

MS management:

  • acute relapse?
  • for fatigue?
  • for spasticity?
  • bladder dysfunction?
  • oscillopsia (visual field oscillation)?
A

Relapse: IV methylpred 5 days - shortens relapse but no effect on recovery

Fatigue:

  1. Rule out anaemia, thyroid, depression
  2. Amantadine
  3. Mindfulness, CBT

Spasticity:

  1. Baclofen
  2. Gabapentin
  3. Diazepam, Dantrolene or Tinzadine

Bladder - urgency, frequency, overflow, incontinence etc:
1. bladder USS to assess residual volume
2. If normal residual volume, anticholinergics may help frequency
3. If significant residual volume - intermittent self-catheterisation
(be aware anticholinergics may worsen symptoms)

Oscillopsia:
- Gabapentin

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44
Q

DMARDs for MS?

A

B interferon

Glatiramer acetate - immunomodulator

Natulizumab - recombinant MAb, against leucocytes, prevents crossing of BBB

Fingolimod - prevents lymphocytes leaving lymph nodes

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45
Q

Hoarseness and uvula deviating to right?

A

Left vagus nerve lesion

uvulAWAY from side of lesion

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46
Q

What tracts are affected in SACD?

A

DCML - proprioception, vibration

Lateral corticospinal - spasticity, brisk knee reflexes, positive babinski
ankle jerks typically lost

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47
Q

Chronic form of Guillain barre?

A

Chronic inflammatory demyelinating polyneuropathy

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48
Q

Causes of CNIII palsy?

What is seen?

A

Causes:

  • diabetes
  • Uncle herniation through tentorium cerebelli in raised ICP
  • Posterior communicating artery aneurysm (painful)
  • vascular (vasculitis, cavernous sinus thrombus, Weber Syndrome - midbrain stroke)

Signs:

  • down and out eyeball
  • dilated
  • ptosis
  • pupil won’t constrict to light, but light shone in that eye causes consensual constriction
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49
Q 
Cerebral venous sinus thrombosis:
- presentation of sagittal?
- cavernous?
- lateral?
Gold standard Ix?
A

All have insidious onset over hours-days of severe headache, N&V

Sagittal:

  • may cause seizures and hemiplegia
  • parasagittal wartershed infarcts may be seen

Cavernous:

  • periorbital oedema
  • ophthalmoplegia - 6th nerve before 3rd and 4th
  • central retinal vein thrombosis
  • 5th nerve involvement may cause hyperaesthesia of upper face/eye pain

Lateral:
- 6th and 7th nerve palsies

Ix: MRI venogram

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50
Q

Degenerative cervical myelopathy Ix?

Rx?

A

MRI

Decompression surgery - best outcome within 6 months
Physio should only be initiated by specialists as manipulation can worsen spinal cord damage

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51
Q

Cushing’s triad?

A

Bradycardia
Irregular breathing
Hypertension with a WIDE pulse pressure

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52
Q

Left sided facial weakness - what side and U/L motor neurone would be affected and how can you discriminate?

A

Left facial weakness

Right Upper motor neurone
If the forehead muscles are spared

Left Lower motor neurone
If the forehead muscles are affected

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53
Q

Causes of bilateral facial muscle weakness?

A 
GBS
Sarcoidosis (parotid swelling)
Lyme disease
Bilateral acoustic neuromas (NF2)
Bell's palsy - 1% Bells Palsy are bilateral but Bells Palsy causes 25% bilateral facial weakness
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54
Q

Causes of LMN facial palsy?

A 
Bell's palsy
Ramsay Hunt Syndrome 
Acoustic neuroma
Parotid tumour
HIV
Diabetes
MS (may also cause UMN)
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55
Q

Can Bell’s Palsy be painful?

A

Yes in 50% there may be some pain

If no vesicles in ear though then not Ramsay Hunt

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56
Q

How to test if fluid from er/nose is CSF?

A

Bedside - glucose - esp in trauma

Gold standard - beta-2 transferrin (but this takes about a week to get back)

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57
Q

MND - features of:

  • ALS?
  • Primary Lateral Sclerosis?
  • Progressive Muscular Atrophy?
  • Progressive Bulbar/Pseudobulbar Palsy
A

ALS:

  • UMN and LMN signs
  • familial - chromosome 21
  • 25% have bulbar onset

PLS:
- UMN signs only

Progressive muscular atrophy:

  • LMN signs only
  • Distal before proximal
  • best prognosis

Progressive Bulbar Palsy:

  • Palsy of muscles of chewing, swallowing and face - brainstem motor nuclei
  • worst prognosis

(bulbar = LMN, pseudo bulbar = UMN of corticobulbar tracts)

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58
Q

Difference between spasticity and rigidity?

A

Spasticity:

  • caused by motor tract UMN e.g. cortex, brainstem, corticospinal tract
  • On quick movement there is initial resistance which melts away, no resistance on slow movement (‘clasp knife’)

Rigidity:

  • caused by extrapyramidal e.g. basal ganglia
  • resistance on slow movement, and doesn’t melt away on quick movement
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59
Q

MOA of ondansetron?

Where does it act?

A

5-HT3 antagonist

CTZ in the medulla

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60
Q

1st line management of absence seizures?

A

Sodium valproate or ethosuxomide

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61
Q

If patient is brought into A&E in a status, most important 2 causes to rule out first?

A

Hypoxia

Hypoglycaemia

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62
Q

Precipitants of migraines?

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise
63
Q

Which type of Parkinson’s treatment is most linked with impulse control issues?

A

Dopamine agonists

Bromocriptine, Ropinirole, Pramipexole, Cabergoline

Gambling, sexual, food etc

64
Q

4 features of acoustic neuroma?

A

Tinnitus
Vertigo
Hearing loss
Absent corneal reflex

65
Q

ACA stroke?
MCA stroke?
PCA stroke?
Basilar stroke?

A

ACA:

  • contralateral hemiparesis/sensory
  • lower extremity worse

MCA:

  • contralateral hemiparesis/sensory
  • upper worse then lower
  • contralateral homonymous hemianopia
  • Aphasia

PCA:

  • contralateral homonymous hemianopia with macular sparing
  • visual agnosia

Basilar:
- locked in syndrome

66
Q

Anterior inferior cerebellar stroke?

A

Lateral Pontine Syndrome

  • ipsilateral facial pain/temperature
  • Contralateral pain/temperature loss
  • ipsilateral ataxia, nystagmus

so far same as PICA, but with addition of…

  • ipsilateral facial paralysis and deafness
67
Q

Posterior inferior cerebellar stroke?

A

Lateral medullary syndrome
Wallenberg syndrome

  • ipsilateral facial pain and temperature loss
  • contralateral limb pain and temperature loss
  • ipsilateral nystagmus
68
Q

Weber’s Syndrome?

A

Stroke of PCA branches that supply midbrain

  • ipsilateral CNIII palsy
  • contralateral weakness of both limbs
69
Q

1st line and 2nd line options for generalised tonic clonic seizures?

A

1st - valproate

2nd line - lamotrigine, carbamazepine

70
Q

1st line options for absence seizures?

What might make them worse?

A

1st - valproate or ethosuximide
(Valproate esp good if co-existent tonic-clonic)

DO NOT give carbamazepine - might make it worse

71
Q

1st line and 2nd line options for myoclonic seizures?

A

1st - valproate

2nd - lamotrigine, clonazepam

72
Q

1st line and 2nd line options for focal seizures?

A

1st line - carbamazepine or lamotrigine

2nd line - levetiracetam, oxcarbazepine, valproate

73
Q

When can antiepileptic drugs be stopped and over how long should they be withdrawn?

A

Seizure free for >2 years and stopped over 2-3 months

74
Q

Anticoagulation therapy post-stroke if AF is the cause?

A

Warfarin or DOAC

Xa inhibitor e.g. apixaban, or direct Thrombin inhibitor e.g. dabigatran

75
Q

Stroke:

  • Apart from thrombolysis, what should be started in the first couple of days?
  • What is the exception to this?
  • Long-term treatment after acute stroke?
  • BP target after stroke?
A

Aspirin within 24 hours
Statin within 48 hours
(or alternative anti platelet if aspirin not tolerated)

If on anticoagulant (e.g. for prosthetic valve) stop it for 7 days and start aspirin after this

If from AF - start warfarin/DOAC
If not - start clopidogrel
After 2 weeks

Aim for BP<130/80, try to avoid B blockers

76
Q

Common peroneal nerve lesion features?

A
  • weakness dorsiflexion (deep)
  • weakness eversion (superficial)
  • weakness extensor hallucis longus
  • wasting of anterior tibial and peroneal (lateral) muscles
  • sensory loss dorsum of foot and lateral lower leg
77
Q

What is seen on LP with GBS?

What antibodies can be tested for?

A

increased protein
normal WCC

anti-ganglioside

78
Q

Side effects phenytoin? (6)

A 
Gingival hyperplasia
Hirsutism
Megaloblastic anaemia
Peripheral neuropathy
Lymphadenopathy
Osteomalacia (enhanced VitD metabolism)
79
Q

in TIA, what are the only 3 occasions aspirin should not be given immediately?

A
  1. Patient has bleeding disorder or is taking anticoagulant - admit immediately for imaging to rule out stroke
  2. Patient is already taking low-dose aspirin - just continue this until seen by specialist
  3. Aspirin is contraindicated
80
Q

Red flags which prompt immediate referral in trigeminal neuralgia?

A
  • sensorineural hearing loss
  • symptoms or FHx of MS
  • optic neuritis
  • only affecting ophthalmic division
  • bilateral
  • sensory change
  • <40 y/o
81
Q

What is important to tell pts taking levodopa?

What is used as rescue medication for acute ‘off’ states?

A

Must be taken at same time each day

Apomorphine

82
Q

Anti-emetic to be used for Parkinson’s?

A

Domperidone

83
Q

Features of corticobasal degeneration?

A

Parkinson’s plus sydrome

Rigidity and muscle weakness in one limb with apraxia (loss of purposeful movement)
Phantom limb phenomenon

84
Q

Difference between postural tremor and intention tremor?

Causes of each

A

Postural - worse when holding arms out, persists during movement but doesn’t get worse during the movement

Causes: anxiety, alcohol withdrawal, hyperthyroid, salbutamol, caffeine, lithium, valproate, TCA, essential

Essential - AD

Intention - task oriented, made worse throughout range of movement

Causes: cerebellar disease (MS, stroke), Wilson’s disease

85
Q

Causes of dystonia (not acute like antipsychotics):

  • cervical?
  • eyes?
  • jaw?
  • vocal cords?
  • limbs?
A

Cervical - muscle strain, OA

Eyes - myasthenia, dry eyes

Jaw - myasthenia, TMJ dysfunction

Vocal cords - laryngitis, polyps
(coarse, strained voice)

Limbs - overuse, nerve entrapment

86
Q

Management of dystonia?

A

Anti-spasmodic: Baclofen

Focal: botulinum injection

Acute: Procyclidine

87
Q

What is a chorea?

A

Non-rhythmical, irregular, purposeless movement that flits and flows from one body part to another

(e.g. facial grimacing, writhing of shoulders, rapid movements of fingers)

88
Q

Huntington’s:

  • Inheritance?
  • age of onset?
  • Presentation?
  • management?
A

AD - CAG repeat in Chr4 producing a neurotoxin resulting in degeneration of striatum

Usually 4th decade - presents earlier with each generation (genetic anticipation)

Triad of emotional, cognitive and motor neurone disturbance
Early: clumsy, chorea, irritability, depression, agitation
Late: chorea, myoclonus, rigidity, fits, dementia, loss of ability to speak/swallow

Management: supportive - lifespan 15 years

89
Q

Sydenhams chorea?

A

Self limiting chorea seen in children after strep throat infection

90
Q

What is myoclonus

A

Sudden, involuntary muscle jerks - can be normal, abnormal if >5 of these movements

91
Q

Drugs that can cause parkinsonism?

A

Metoclopramide
Antipsychotics]
Amiodarone

92
Q

Causes of myoclonus?

A 
Genetic - benign essential (same as tremor)
Stroke, SOL, head injury
CJD
Levodopa
Alcohol withdrawal
Liver/renal failure
Hyponatraemia
93
Q

What are tics?
Primary tic disorder?
Secondary?

A

involuntary stereotyped movements or vocalisations, which are unable to be suppressed. Attempts to suppress cause anxiety and discomfort, which is relieved upon completing the tic

Primary: Tourettes - start in childhood

Secondary: autism, huntington’s, wilson’s, haemochromatosis - present in childhood or adulthood

94
Q

MND is linked to which type of dementia?

A

Frontotemporal

95
Q

Antibodies for myasthenia gravis?

A

anti-AChR

anti-MuSK

96
Q

Antibodies for LEMS?

Management?

A

Anti-P/Q VGCC antibodies

3,4 - diaminopyradine
IVIG

97
Q

Occipital lobe seizures?

A

Flashes
Spots
Lines
General visual disturbances

98
Q

SE valproate?

A 
Reversible hair loss
Ataxia
Tremor
Pancreatitis
Liver failure
Weight gain
Teratogen - NTD
Thrombocytopaenia
Oedema
99
Q

SE lamotrigine? (4)

A

Maculopapular rash
SJS
DIC
Photosensitivity

100
Q

SE levetiracetam?

A

mood swings

101
Q

SE carbamazepine?

A

Impaired balance
Leucopaenia
Double/blurred vision
Impaired balance

102
Q

What increases risk of SUDEP?

A

poorly controlled
Smoking
Use of illicit drugs

103
Q

DVLA and epilepsy:

  • first unprovoked seizure?
  • epilepsy and seizure?
  • withdrawing medications?
A

First unprovoked seizure:

  • if no structural problem and no epileptic activity on EEG then 6 months
  • if not then 12 months

With epilepsy:

  • can’t drive for a year
  • no HGV for 5 years

Withdrawing medication:

  • cannot drive whilst meds are being withdrawn
  • cannot drive for 6 months after last dose
104
Q

What 2 anti epileptics are P450 inducers?

What one is an inhibitor?

A

Inducer: carbamazepine and phenytoin

Inhibitor: valproate

105
Q

Can valproate and carbamazepine be given to breastfeeding mothers?

106
Q

10 features featuring pseudo seizures?

A 
pelvic thrusting
family member with epilepsy
female
crying after attack
don't occur when alone
gradual onset
no tongue/tip of tongue biting
no incontinence
eyes open
rhythmic/pattern
107
Q

Lhermitte and Uhtoffs signs?

A

in MS:

Lhermitte - electric shock down spine and arms when head bent forward

Uhtoffs - worse in head and exercise

108
Q

Timescale for episodes in MS to be diagnostic?

A

Must last at least 1 hour and be at least 30 days apart

109
Q

If someone has optic neuritis, how many plaques on MRI suggest MS?

A

> 3 plaques in white matter give 50% chance of MS in 5 years

110
Q

LP with MS?

A

IgG oligoclonal bands (that aren’t in serum)

111
Q

Nerve roots:

  • musculocutaneous?
  • axillary?
  • radial?
  • median?
  • ulnar?
A

Musculocutaneous: C5-7

Axillary: C5/6

Radial: C5-T1

Median: C6-T1

Ulnar: C8-T1

112
Q

Nerve roots:

  • lateral cutaneous nerve of thigh?
  • femoral?
  • obturator?
  • sciatic?
  • Tibial?
  • common fibular?
  • superficial fibular?
  • deep fibular?
A

Lat cut: L2/3

Femoral: L2-4

Obturator: L2-4

Sciatic: L4-S3

Tibial: L4-S3

Common fib: L4-S2

Sup fib: L4-S1

Deep fib: L4-S1

113
Q

Causes of mono neuritis multiplex?

A
  • diabetes
  • rheumatoid
  • carcinomatosis
  • Vascilitis: wegeners, PAN
  • HIV
114
Q

Presentation of polyneuritis?

A

Symmetrical and widespread neuropathy, usually begins distally with glove and stocking sensory loss and progressive muscle weakness

Diabetes, B12, wegener’s, HIV, syphilis, alcohol, isoniazid, paraneoplastic

115
Q

What is seen on LP of meningitis caused by:

  • virus?
  • bacteria?
  • TB?
  • aseptic?
A

Virus: high WCC, lymphocytes, normal protein and glucose

Bacteria: Neutrophils, positive Gm stain, high protein, low glucose

TB: lymphocyte predominant WCC, high protein, low glucose

aseptic: all essentially normal, perhaps minimally increased protein

116
Q

What causes progressive multifocal leukoencephalopathy??

A

JC virus

Immunocompromised pts

117
Q

How many attacks of migraine for prophylaxis?

A

2 or more per month

118
Q

Prophylaxis for women with predictable menstrual migraine?

A

Triptan to be taken on those days

119
Q

Triptans:

  • MOA?
  • SE?
  • CI?
A

5-HT1 agonists

SE: ‘triptan effect’ - tingling, heat, heaviness in chest, pressure, tightness of throat

CI: IHD or cerebrovascular disease

120
Q

Prophylaxis of chronic tension headaches?

A

Acupuncture

low dose amitriptyline now widely used but no evidence base

121
Q

Features of cluster headaches?

A

Occur in clusters over a 1-3 month period
Intense, sharp stabbing pain around one eye with lacrimation and conjunctival injection and nasal stuffiness. May have mitosis and ptosis. Lasts 15 mins-2 hours

Acute: 100% oxygen, sc triptan

Prophylaxis: verapamil

122
Q

Features of paroxysmal hemicrania?

A

Similar to cluster headaches, but no cluster of attacks.
Continua version - attacks grow in intensity

Rx: indomethacin

123
Q

Features of TMJ dysfunction?

Management?

A

Cyclical/constant facial pain upon using the jaw, may have abnormal sound when using, tender of masticatory muscles. Often a psych background

NSAIDS
Rest, physio

124
Q

Management of cerebral venous sinus thrombosis?

A

General treatment of raised ICP - head tilt etc

Warfarin +/- heparin
Can be thrombolysed if needed

125
Q

Ix for SAH?
Acute management?
How is hydrocephalus treated?
secondary prevention?

A
  1. CT
  2. LP 12 hours later - xanthochromia
    - > refer to neurosurgery once confirmed

Once confirmed - CT angio for cause

Acute management:

  • induce hypertension with IV saline (maintain perfusion)
  • Nimodipine (21 days, prevents vasospasm)

Hydrocephalus: extra-ventricular drain

Endovascular clipping/coiling

126
Q

Complications of SAH?

A

Rebleed - 50% chance in 6 months

Delayed ischaemia from vasospasm - typically 3-12 days later
-> nimodipine

Hydrocephalus - due to blockage of arachnoid granulations, usually transient, shunt if required

Hyponatraemia - due to SIADH

127
Q

Management of subdural haemorrhage?

A

1st - burr hole craniotomy

2nd - craniotomy

128
Q

Management of epidural haematoma?

A

Clot evacuation and ligation of middle meningeal artery

129
Q

What tumours commonly metastasise to brain?

A 
Lung
Breast
Kidney
Colon
Melanoma
130
Q

Most common primary brain tumour of adults? 4 grades?
Imaging?
Histology?

A

Astrocytoma:
Grade 1 - benign
Grade 2 - largely benign, small malignant potential
Grade 3 - anapaestic astrocytoma (2 year survival)
Grade 4 - glioblastoma multiforme - highly invasive, can develop de novo or from premalignant precursors, survival = 1 year

Imaging: solid tumour with necrotic core and oedema

Histology: pleomorphic cells and necrotic areas

131
Q

2nd commonest primary brain tumour? Histology?

A

Meningioma - arises from dura - round shape

Spindle cells and calcified psammoma bodies

132
Q

Commonest primary brain tumour in kids? Histology?

A

Pilocytic astrocytoma

Histology: rosenthal fibres

133
Q

Medulloblastoma - what is it? histology?

A

Infratentorial brain tumour in kids. Aggressive, spreads through CSF.

Small, blue cells

134
Q

Tumour commonly found in 4th ventricle?

How does it present?

A

Ependymoma

Hydrocephalus

135
Q

What is an oligodendroma?

Histology?

A

Benign, slow growing frontal lobe tumour

Histology: calcifications with fried egg appearance

136
Q

Where do craniopharyngiomas arise?

A

Rathke’s pouch in sellar region

137
Q

1st line imaging for suspected brain tumour?

138
Q

Management of idiopathic intracranial hypertension?

A

Weight loss

Acetazolamide

139
Q

Tabes dorsalis?

A

Neurosyphilis

Loss of DCML modalities only (proprioception and vibration)

140
Q

Anterior cord syndrome?

A

Due to anterior spinal artery occlusion

Bilateral spastic paresis
Bilateral loss of pain and temperature

(due to loss of lateral spinothalamic and lateral corticospinal)

141
Q

Central cord syndrome?
What is affected and why?
Presentation?

A

Usually due to whiplash or in elderly with cervical spinal stenosis

Corticospinal - upper limbs affected (as more central)

Spinothalamic - lost as fibres decussate

Presentation: upper limb weakness and band-like loss of pain, temperature and gross touch

142
Q

Ix for spinal CORD injury with ?

A

CT
MRI for kids

(for trauma - XR first, CT if XR abnormal or if symptoms/signs of spinal cord injury)

143
Q

What tumour is assoc w von Hippel Lindau?

Histology?

A

Haemangioblastoma of cerebellum

Foam cells

144
Q

Who needs to test for brainstem death?

A

2 separate doctors from 2 separate specialties e.g. neurological and anaesthetist

145
Q 
What is pituitary apoplexy?
RF?
Presentation?
Ix?
Management?
A

Sudden enlargement of a pituitary tumour (usually non-functioning macro adenoma) secondary to haemorrhage or infarction

RF: hypertension, pregnancy, trauma, anticoagulation

Pres:

  • sudden onset ‘thunderclap’ headache but felt behind the eye
  • vomiting and neck stiffness
  • bitemporal superior hemianopia
  • extra ocular nerve palsy
  • features of hypopituitarism (hypotension, hyponatraemia etc)

Ix: MRI

Management:

  • urgent steroid replacement due to loss of ACTH
  • careful fluid balance
  • surgery
146
Q

Loss of finger abduction and thumb adduction?

147
Q

Head injury:

  • criteria for immediate CT? (6)
  • criteria for CT within 8 hours? (4)
A

Immediate:

  • GCS <13 initially
  • GCS <15 2 hours post-injury
  • suspected skull fracture
  • post-traumatic seizure
  • focal neurological deficit
  • > 1 episode of vomiting

8 hours:

  • age 65+
  • Hx of bleeding/clotting disorders
  • dangerous mechanism of injury
  • > 30 mins retrograde amnesia before event
148
Q

Focal seizure:

  • lip smacking, plucking?
  • posturing?
  • paraesthesia?
  • flashes/floaters?
  • head/leg movements?
  • hallucinations?
  • epigastric rising?
  • post-ictal dysphasia?
A

Lip smacking (automatisms) - temporal lobe

Posturing = frontal lobe

Paraesthsia = parietal lobe

Flashes/floaters = occipital lobe

Head/leg movements = frontal lobe

Hallucinations = tempora; lobe

Epigastric rising = temporal lobe

Post-ictal dysphasia = temporal lobe

149
Q

Hyponatraemia following head injury?

150
Q

Head injury - diplopia and difficulty opening mouth?

Orbital blowout fracture - what bone?

A

Zygoma fracture

Blow out: maxilla

151
Q

Ix for MS?

A

MRI brain and spine with contrast

152
Q

Food drop, loss of hip abduction, all reflexes intact?

A

L5 radiculopathy

153
Q

Initial steps in haemorrhage stroke/haemorrhagic transformation?

A

Stop/reverse any anti platelet/anticoagulant drugs

Maintain BP to a target 140mmHg systolic

Finals Revision (29 decks)

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